Basic Information
| Provider Information | |||||||||
| NPI: | 1891714275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMBERTH | ||||||||
| FirstName: | WADE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2022 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | SUITE 403 ACC | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058772627 | ||||||||
| FaxNumber: | 2058717602 | ||||||||
| Practice Location | |||||||||
| Address1: | 2022 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | SUITE 403 ACC | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058772627 | ||||||||
| FaxNumber: | 2058717602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 5592 | AL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 51514970LAM | 01 | AL | BLUE CROSS OF ALABAMA | OTHER | P00010093 | 01 | AL | RR MEDICARE | OTHER |